A Union in sickness and in health

We all want to have the best possible treatment when disease strikes us or our loved ones. But unfortunately the best treatment, especially for serious and complicated illnesses, may not be available in our own country. What then? We are faced with the stressful dilemma: either to receive a second-class treatment at home, entirely free of charge or quite cheap, or to seek therapy in an advanced medical centre abroad and to pay all the associated bills out of our own pocket. Those who are very rich can afford to get any treatment anywhere in the world. But most people will usually accept, with some degree of resentment, therapy in their home country. Those that choose otherwise will most probably face extreme financial hardship.

In a 21st century, mainly state-sponsored, healthcare system, is this fair and proper?

Some may argue that, like many other circumstances in life, money can buy everything, including healthcare and, therefore, there is nothing wrong with the same principle applying here. Others, the majority I hope, will say that, in facing ill-health we should all be equal.

But how can this be achieved? Probably in two ways: either the state is forced to reimburse the cost of medical treatment abroad or we must make sure that our own health systems offer very high standards of healthcare. These two alternatives are not necessarily mutually exclusive. If a government has to face enormous overseas reimbursement costs it will make a much more determined effort to improve its medical services, so as to keep its patients at home. At the same time, such a government will start looking at the benefit of attracting patients and revenue from abroad. Additionally, in cases of very rare diseases or injuries, super-specialist referral centres will be formed in one or two countries where patients can be sent trans-nationally, thus significantly cutting down running costs. And of course, with the increased demand and the much increased experience, the quality of the service offered will improve.

There is also a part for competition to play in offering ‘the best’ medical service for a particular health problem. Such competition will clearly be beneficial to the patient, but also to the patient’s home country government for, by getting the proper treatment, the patient will, most likely, be free from complications and recurring problems and will also be a satisfied citizen. In addition, the home country will not need to invest hugely in expensive medical equipment and manpower for dealing with not so commonly occurring medical conditions.

So, in cases where treatment in another country is necessary, by virtue of being ‘medically better’, the wise approach is that the citizens who are ill must be given all the help necessary to get that treatment. Such help should include the contacting and referral procedure, as well as assistance with transport and reimbursement of costs, or, better, direct payment of costs by the home country to the referral medical centre abroad. Special arrangements can be made whereby there is continuous and streamlined co-operation between medical services in different countries so as to have a smoothly functioning and efficient system of patient transfer, with minimal inconvenience to the sick and avoiding distressing and hindering bureaucracy.

But there are also cases where the choice of another country to have treatment may not be based on conditions directly linked to the standard of treatment per se. A good example is a patient wanting to combine a ‘cold’ surgical procedure with a recuperation holiday. The patient’s choice, in such a case, could be to have the medical treatment in a warm, sunny, seaside resort location, where, after the medical procedure, the patient will recuperate for a few days in holiday surroundings. This would speed up recovery and would be much more pleasant for both the patient and his/her spouse. In such cases, which include for example many non-urgent orthopaedic operations, the patient’s right to choose should be respected, with full re-imbursement, as long as the cost is not greater than that for the same treatment at home. In fact, in many instances due to ‘medical tourism’ competition, the cost of having such operation abroad may be much lower than having the procedure at home.

It is in everybody’s interest (that of the patient, the patient’s family, the medical centre abroad and the patient’s government) that citizens should have the right to choose the country where they receive treatment.

Cypriot Liberal (ALDE) MEP Marios Matsakis is a member of the Eurpean Parliament’s environment, public health and food safety committee.

Evelyne Gebhardt

Whatever the situation of the patient – a tourist falling ill, retired people living in another member state, a student living abroad – every EU citizen, regardless of whether he or she is a private or public patient, should be guaranteed equal and affordable access to healthcare in accordance with the principles of universality, quality, safety, continuity and solidarity. Ideally, all member states should treat citizens of another member state on an equal basis concerning access to health services.

Unfortunately, this is not yet the case and it seems that this demand can hardly be met by the member states individually. According to the treaty it is primarily the responsibility of each member state to provide efficient and high quality healthcare. But it is necessary to deal with the question of cross-border healthcare services at EU level. Many of the problems that both patients and health service providers face with cross-border health care, such as the lack of precise information on patients’ rights, uncertainty about the reimbursement of healthcare costs or complex procedures, could be more efficiently solved through common European measures. The existing case law of the European Court of Justice and the provisions for the mutual recognition of professional qualifications remain insufficient in this regard and are not always properly applied.

An important aspect which clearly shows the need for action on EU level is access to information, both concerning patients and healthcare professionals.

A patient seeking medical treatment abroad expects that the healthcare provider is fully qualified, that the service is of at least the same quality as in the patient’s country and that there is a liability in case of injury.

At the moment, there is no legal certainty for this, as the regimes of legal liability vary a lot between member states and are not very transparent. Liability is of great importance to both patients and service providers, which is why we need an obligation for all health professionals to have compulsory third-party liability insurance at reasonable cost.

In order to improve the information about the accessibility of services, the liability regimes or the best treatments, it would be useful to create a so-called point of single contact in the member states. They could guarantee the access to independent information for patients, healthcare professionals and institutions. Furthermore, national authorities in the member states should co-operate more and establish networks to share information on the organisation of the healthcare systems, on professional training or with regard to the registration and disciplinary information of healthcare providers. These measures would improve patient safety and the quality of healthcare services equally.

Health services are services of general interest and as such, they are not comparable with normal commercial services – the usual rules of the market do not apply for them. This is the reason why healthcare has been excluded from the scope of the services directive. According to Article 35 of the Charter of Fundamental Rights, the EU shall ensure a high level of health protection. In order to guarantee high quality standards of healthcare, we need a legislative instrument that takes the special character of health services into account.

An increase in mobility could improve the general accessibility of healthcare, but it should not be an end in itself. Member states should be aware that most European citizens still need accessible and affordable healthcare in their neighbourhood and cannot afford a trip abroad to get an appropriate medical treatment. They should not forget to improve their own healthcare systems.

German Socialist (PES) MEP Evelyne Gebhardt is a member of the Parliament’s internal market and consumer protection committee and drafted its report on the services directive.